Recognising Dying

Being prepared for the death is important.

Terminal care planning should lead to a structured care plan which details essential steps for the care of the dying person and any specific clinical problems they have or are likely to encounter.

This will help ensure care that is focused on the individual’s needs.
A terminal care plan will enable:

• Frequent reviewing with the older person and their caregivers current priorities and focus of care.
• Care is more sharply focused on the older person’s physical, emotional and spiritual comfort.
• A terminal care plan is patient and family centred and encompasses all the holistic needs associated with dying.
• Symptom management is considered within the context of dying.
• Consideration of psychosocial and spiritual concerns of the older person and their family.
• Support of the family and caregivers into the bereavement period.
• Cessation of burdensome interventions that do not improve the comfort of the older person.

The review monitoring that forms part of the terminal care plan means that if the person shows signs of improvement, a review of the appropriateness of continuing on the plan would occur.

Nurses have a major role in providing care in the last days of life.

• They will be a resource and continuity for the person and their family.
• They will be able to monitor that symptoms are being managed effectively.
• They can help the person and the family understand the dying process and provide reassurance.
• They will be an important point of communication between the dying person and the family, and other health and care providers.
• They can assist the family in knowing what needs to be done after a person dies.  
• They can offer emotional support and understanding.

Nurses can also consider the actions they can take to support care in the last days of life including:

• Recognising when a resident is approaching the terminal phase and organising care strategies including end of life medications to facilitate a peaceful and dignified death.
• Keeping older person / family informed of changes in the older person’s condition as well as changes in treatment strategies.
• Requesting that the medical officer or nurse practitioner pre-emptively prescribe and chart medication orders to manage common end-of-life symptoms.
• Monitoring swallow and, if it deteriorates, requesting oral medication orders be re-charted using an alternative route or ceased if no longer required.
• Regular reassessment of symptoms and the efficacy of administered medication.
• Monitoring for medication side effects.
• Organising Medical Officer / Nurse Practitioner review if symptoms are not well managed or if medication is not tolerated.
• Initiating appropriate non-pharmacological strategies to manage symptoms.
• Contacting the Medical Officer, Nurse Practitioner or local Specialist Palliative Care Service for further advice if symptoms are not responding to treatment.

Unexpected symptoms may occur. Families may find the dying process confronting and difficult.
Many issues may lead to the need to rapidly reconsider the planning.
Options for additional support include contacting the GP or service provider.

If the issue is severe, referral or advice from a local specialist palliative care service should be considered.

Nurses can ensure that family and staff are aware of what needs to happen after someone dies. This can include care of the body, certification of the death and the role of funeral companies. A doctor needs to sign a certificate confirming death before the body can be moved. Make sure those who need it have contact details to enable death certificate completion and contacts for funeral directors.

• palliAGED
  • Understanding the Dying Process
  • Education on the run videos which deal with care and symptoms issues
  • Symptoms and Medicines which guide evidence-based practice in the care of older people in the last days of their life (terminal phase).
• eviQ Opioid Conversion
  • Use the EviQ opioid calculator to assist with estimating equianalgesic doses of opioids.
    Tool use is free. Site registration is required
• CareSearch website
  • Information for GPs - The Dying Patient
  • Information for Nurses - After Death Care
• National Palliative Care Service Directory
  • The National Palliative Care Service Directory managed by Palliative Care Australia provides information about specialist palliative care service providers, state or territory palliative care organisations and community support agencies.